NPIMap

Torey Charlise Davis-Bogan, SA-C, CST

Individual provider Active NPI Surgical Physician Assistant · Marietta, GA

NPI 1003455874 · NPPES record last updated Feb 21, 2022

Key facts

NPI
1003455874
Entity type
Individual (NPI type 1)
Primary specialty
Surgical Physician Assistant 363AS0400X
License
18-399 (GA)
Practice address
3105 Rome CT SW
Marietta, GA 30064-4423
Phone
(317) 664-0771
NPI assigned
Dec 27, 2019
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
18-399GAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rising Surgical Services, LLC Surgical Current
since Aug 28, 2022		 Accepting new patients
Oasis Surgical Assistants, LLC Surgical Past
since Mar 1, 2020		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 18-399 GA Yes

Addresses

Primary practice location

3105 Rome CT SW
Marietta, GA 30064-4423

Mailing address

3105 Rome CT SW
Marietta, GA 30064-4423
Phone (317) 664-0771

Other providers in Marietta, GA

All providers in Marietta, GA · Surgical Physician Assistant in Georgia

Sources for this page

Verify at the official NPI Registry.